Have you noticed that some parts of your skin are dry while other parts are oily? This is known as combination skin. Combination skin is characterized by an oily T-zone while the cheeks are either normal or dry. How to tell if you have combination skin? Wash your face with your normal cleanser, then wait an hour. If your T-zone is oily whereas your cheeks are either normal or dry, you have combination skin.
Combination skin is thought to be one of the most common skin types. When it comes to skincare routines, hydrating creams are too hydrating, oil-absorbing masks are too absorbing, balancing lotions never seem to do much balancing… It can be tricky to figure out how to care for your skin properly.
Dr. Teo Wan Lin is an accredited dermatologist and an expert on cosmeceutical skincare research and development. She is the author of “Skincare Bible – Dermatologist’s Tips for Cosmeceutical Skincare” which was published July 2019 by leading bookstores Barnes & Noble, Baker & Taylor and Apple Books and available in bookstores islandwide from January 2020. She heads up Dr.TWL Dermaceuticals, a specialist cosmeceutical skincare line with evidence-based active ingredients for anti-ageing and skin health. Its subsidiaries, the Pi- Cosmeceutical Custom Makeup Lab and the Conscious Mask Bar are part of the Conscious Concept Pharmacy launched in December featuring environmentally sustainable makeup and skincare materials. In this series “Dermatologist Talks” she shares her top tips on common skincare topics. In this article, she tells us the science behind combination skin – skin that is both dry and oily.
Skin that is both dry and oily boils down to an underlying pathology of the skin which is much more common in acne-prone individuals is known as seborrhea, which is overactivity of the oil gland. It is part of the causes of teenage and adult acne. Even when you have seborrhea, it is possible for you to have a deficiency in the ceramide content of your skin barrier leading to dry skin.
The production of ceramide is genetically determined. You could have inherited both the genes for oily skin as well as dry skin. The commoner scenario we see would be someone with acne and oily skin who started using over the counter medication such as those that contain retinol or benzoyl peroxide and these will break down the skin barrier and it can result in the skin being dry, sensitive and acne-prone.
Individuals with combination skin often have breakouts over the greasy T-zone area. This can be exacerbated, in the case of some women, especially during the time of their monthly menstrual cycles. On the other hand, their cheek areas can be very dry and when they travel, especially when there is a change in climate, these areas can become dry, flaky and sensitive especially if they are using skincare that is slightly harsher on their skin.
The recommended skincare routine for combination skin should address both the oiliness of the T-zone, which can sometimes get quite uncomfortable especially in a humid climate like Singapore, as well as the potential dryness that may occur over the cheek areas. An important thing to note would be a gentle emulsifying cleanser is recommended for combination skin such as the Honey Cleanser.
Honey itself is a natural emulsifier which means it produces foam without the need for strong chemical lathering agents such as the laureth sulfates. At the same time, it is a natural humectant which means that it traps moisture under the skin. As a result, it helps to balance out the production of sebum without over-stripping the skin of its natural oils.
Individuals with combination skin should focus on using hydrating serums such as Hyaluronic Acid Serum, Vitamin C Serum and Elixir-V Serum as these contain cosmeceutical active ingredients which function as treatment over their T-zone to regulate oil production.
Also, use hydrating emulsions rather than creams, the former is an oil in water mixture rather than a pure cream formula. This helps to moisturize the skin without the cream becoming too thick or greasy. Finally, the excess grease over the T-zone can be addressed with the use of blotting papers (such as those infused with active ingredients like cannabis sativa). These blotting papers are infused with cannabis sativa, an extract of the hemp plant which helps to moisturize the skin and regulate oil production, at the same time physically removing excess grease over the T-zone. One should follow with a hydrating mist such as the Mineral Booster which helps to regulate the skin barrier.
In patients with Eczema, there is an inherent defect of the epidermal barrier of the skin. When this barrier is compromised, bacteria and allergens are able to enter and thus there is an increased risk of secondary infections, which, in turn, can lead to aggravation of eczematous symptoms. It is believed that the best way to manage eczema is to repair the skin barrier or prevent its dysfunction, in which ceramide moisturisers play a critical role.
According to accredited dermatologist Dr Teo Wan Lin who is an expert on sensitive skin and eczema, “I formulated the Dr Twl Dermaceuticals Multi-CERAM™ Moisturiserafter years of prescribing other brands of ceramide moisturisers which I found did not meet the underground clinical needs of patients, at a competitive price point. The high cost of manufacturing ceramide moisturisers lies in its reliance on synthetic sources of ceramide as well as bovine (cow derived) ceramide.”
“In the Dr Twl Dermaceuticals Multi-CERAM™ Moisturiser, which is very competitively priced with a high ceramide content, the novel focus and dermatological concept is on using multiple sources of ceramide for total skin lipid restoration, rather than just relying solely on the expensive synthetic and animal derived ceramide which results in low concentrations of ceramide being used in other ceramide moisturisers, or high price point which is prohibitive.
In the Multi-CERAM™ Moisturiser, phytoceramides are used — these are plant seed oil derived sources of ceramide that directly repair the skin barrier. This is in addition to containing plant anti-oxidants which incidentally combat cellulite, large amounts of glycerin which functions as a humectant, preventing trans-epidermal water loss, as well as Sodium Hyaluronate (Hyaluronic acid), a natural component of the skin, for dermal hydration,” Dr. Teo says.
What are Ceramides?
Ceramides are lipids that are naturally found in the intercellular “mortar” within the outer layer of s the statue corneum. They make up 40-50% of the lipid component of the lamellar lipids and are integral to the function of the epidermal barrier.
In patients with psoriasis, eczema and other dry skin conditions, reduced levels of Ceramides are observed.
The stratum corneum is comprised of corneocytes compressed within a lipid bilayer, which is made up of 40-45% Ceramides, 25% Cholesterol & 10-15% Free Fatty Acids. If incorporated in the wrong ratio, barrier repair may be impeded. These 3 major components of the stratum corneum bind the protein-rich corneocytes into a water impermeable protective barrier. A deficiency in Ceramides results in excessive transepidermal water loss, dry skin and increased permeability to environmental irritants, allergens and microorganisms. Thus, reduced levels of Ceramides is associated with dermatological disorders such as atopic dermatitis.
Studies show that if topical ceramides is applied in the correct ratio with cholesterol and free fatty acids, it can help to improve the epidermal barrier in people with Atopic Dermatitis (AD), thereby reinforcing barrier function. Therefore, ceramide moisturisers and cleansers have been proven to provide substantial relief from the symptoms of eczema.
Ceramide Dominant PED for Eczema
In order for ceramide-containing products to have a positive effect on the skin barrier function, ceramides should be present abundantly in an optimal ratio with other barrier repair ingredients. Our Multi-CERAM Moisturiser is uniquely formulated to ensure the delivery of an optimal ceramide, cholesterol and free fatty acid ratio. In fact, this moisturiser is formulated as a Prescription Emollient Device (PED), the gold standard in eczema management – Eichenfield et al. (2014) [on PubMed], and also the optimal moisturer for barrier protection against maskne – Teo (2020) [on PubMed].
By restoring healthy barrier function, the Dr. TWL Dermaceuticals Multi-CERAM Moisturiser helps to support ceramide synthesis and further augmenting skin barrier repair and skin health in general.
The Multi-CERAM™ Ceramide Moisturiser is uniquely formulated treat Eczema using:
Ceramide 1 (EOP) which is significantly deficient in eczema patients and Ceramide 3 (NP) which is linked to the transepidermal water loss experienced in eczema patients.
Phytoceramides which aids the repair of skin barrier
Sodium Hyaluronate for skin hydration
Ceramide complex (ceramides, cholesterol & FFA) which delivers ceramides topically in optimal ratios to aid in the reinforcement of the recovery of the skin barrier.
Management for patients with Eczema
A daily maintenance routine is vital. One of the main changes in eczema is a disruption and reduction in the layers of corneocytes in the stratum corneum. When the stratum corneum is well hydrated, it swells, allowing increased permeability of topical formulations. The key to managing eczema is through the regular use of a ceramide moisturiser with high ceramide content after showering or washing hands.
Successful management requires a holistic approach:
1. Avoid triggering factors 2. Maintain skin care through regular use of a moisturiser and a moisturising cleanser 3. Pharmacotherapy during acute exacerbations 4. Compliance of skin care products suggested by a dermatologist
Any detailed research you may have done about the skin would have returned you with the term ‘skin barrier’, or in scientific terms the ‘stratum corneum barrier’. You may be aware of how important the skin barrier’s function can affect the condition of the skin, but how exactly does the skin barrier work?
Skin hydration and the stratum corneum barrier has been active areas of study for many years. Yet, consumers are only beginning to get their interest piqued about the skin barrier, largely due to many marketing techniques. Before you commit to any product or treatment that promises to ‘repair’ the skin barrier, have a read on what these terms and processes mean.
The Stratum Corneum Skin Barrier
The skin barrier prevents foreign material from entering the human body. But it does more than just that. It also prevents water loss and serves as a shield against environmental factors. The barrier works to maintain the body’s homeostasis (or stable equilibrium) level. The loss of water from the body through evaporation from the surface of the skin is common, thus a need to keep our corneocytes hydrated.
Corneocytes are the cells found in the stratum cornum layer, that is the outermost layer of the epidermis. These cells are formed through cornification, where the skin cells develop tough protective layers or structures, creating a physical barrier for the skin. When deprived of water, dry skin may be more prone to crack open at stress.
The environment’s humidity also affects the corneocytes. As the level of humidity can vary, corneocytes get their source of hydration from the body, in order to maintain equilibrium with the environment. This may explain why our skin feels drier in winter. The skin battles harsh winds, depleting the skin’s moisture layers.
Skin Barrier Hydration
Skin hydration is an important factor when considering how to attain healthy skin. We look at the stratum corneum’s water content when analyzing skin hydration, with healthy skin containing more than 10 per cent water.
A mixture of water-soluble compounds called natural moisturizing factor (NMF) have been found to affect water content levels. The arrangement of lipids (fats) in the stratum corneum is also important, as it serves as an effective barrier to the passage of water through the layer. A poor arrangement can lead to transepidermal water loss (TEWL). TEWL is essentially when water diffuses and evaporates from the skin surface. Even though this is a natural process, excess TEWL is undesirable as it can lead to many unwanted skin conditions.
TEWL and Moisturizers
TEWL has been one of the most commonly used methods in the skin care industry to measure skin hydration as it directly correlates with skin barrier dysfunction. Healthy skin would score a low TEWL value as it would mean less water loss.
In the same vein, most moisturizers are put to the test by using TEWL values. A good moisturizer should help decrease TEWL. Moisturizers have remained as a ‘staple’ in basic skincare. Yet, not many may fully understand its function, thus some are unable to choose a suitable moisturizer for their skin needs. An effective moisturizer should protect the skin by stimulating and augmenting its natural barrier function, whilst catering to the skin’s requirement for moisture. Environmental attacks on the skin are also shielded with a proper moisturizer which can slow down skin ageing.
What happens if the water content of the stratum cornum falls below a desirable level? Normal desquamation is not able to take place, that is the shedding of the outermost skin layer. With insufficient hydration, skin cells will adhere to one another and accumulate on the surface layer. Visible changes associated with this phenomenon include dryness, roughness, scaling and flaking.
Certain cosmetic ingredients have become a cult favourite in recent years by targeting the stratum cornum water content, such as glycerol (also known as glycerin) and hyaluronic acid.
This ingredient exists in the stratum cornum as a natural endogenous humectant. It has shown that changes in the stratum cornum’s water content correlate with the glycerol content in the layer. Such results have driven the development of glycerol-containing moisturizers. Check the ingredient list of your moisturizer, this star ingredient should appear in any effective moisturizer.
Though it is known as a major component of the dermis (deeper layer of the skin), hyaluronic acid is also found present in the outermost layer. It plays an important role in regulating the skin barrier function and hydration. Although the skin care industry may recognize hyaluronic acid as a powerful humectant (attracts water to hydrate the skin), this molecule also participates in cellular functions. Hyaluronic acid influences cell-cell interactions that lead to normal structure of the skin barrier.
Though the mechanisms for skin hydration remain complex, a simple understanding about the skin structure and function is crucial when looking for an appropriate product or treatment. With these complex terms tackled, you are now one step closer to understanding your skin and its needs. If your current skincare routine does not yield desired results, you can consider cosmeceuticals as the alternative. A combination of ‘cosmetics’ and ‘pharmaceuticals’, cosmeceuticals are products with bioactive ingredients that can bring pharmaceutical effects to the skin barrier and health.
With Singapore’s humid weather, most of us fall back on body lotions and moisturizers to keep our skin smooth and hydrated all year round. Yet, faced with a multitude of choices for body moisturisers, we may never know where to begin – here are some quick tips to help guide the choice of body moisturisers.
Read the product’s ingredient list
This is no easy feat, but it pays to know what is in your product. You need not know all the ingredients in detail, a simple trick would be to scrutinise the order in which the ingredients are presented. Right at the top would be the ingredient with the highest percentage, and the concentration of each ingredient decreases with a descending order of mention in the ingredient list.
The first five ingredients or so usually make the bulk of your product. Given that, it does not necessarily translate that an ingredient has to be in greatest concentration for the most impact. Certain ingredients work well at low concentrations.
One tip would be to watch out for creams or lotions that have the highest concentration of water or plain silicones. While these constituents may give the instant feel of moisture, they quickly disappears and do not repair our skin barrier.
How do moisturizers work?
The most essential feature is to increase the water content of the stratum corneum. The ‘valleys’ between skin contour ridges smoothen with hydration, allowing the skin to be more soft and supple.
Ingredient you want in your moisturizer: ceramides
Ceramides are an essential lipid component of the stratum corneum, the outermost layer of our skin that is largely recognized as the skin barrier. Preventing unwanted materials from entering, it can be seen as our skin’s first line of defense. Ceramides contribute to the permeability of the skin barrier by mediating with cell signaling and with processes such as cell growth, differentiation, proliferation and cell death as a lipid messenger.
A deficiency of ceramides in our skin causes a decrease in water-holding capacity and barrier function. Conversely, with a topical application of phytoceramides, barrier abnormalities are improved and impaired skin barrier function can also be repaired. Thus, if you are looking for a good body lotion or moisturizer, phytoceramides definitely should be on your ingredient check list.
Phytoceramides: What are they?
Phytoceramides are derived from plant-oil and it mimics the lipid component of our skin barrier. With an equivalent function of restoring the skin integrity, we can rely on moisturizers with phytoceramides to repair our skin barrier as do synthetic ceramides do.
Ingredient you want in your moisturizer: glycerin
Glycerin is a natural humectant found in our skin and contributes to normal hydration levels of our skin. Topical glycerin helps to correct the hydration abnormality in our skin, causing glyercol to be included in topical dermatological preparations.
Humectants are hydrophilic compounds that hydrate the stratum corneum when they form hydrogen bonds with water molecules. Glycerin is a typical, yet effective water-binding agent. Humectants draw water to our skin from two difference sources: from a humid environment or from deeper layers of our skin. By absorbing water from these sources, it locks in the moisture in our skin.
According to Dr Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin and Laser Centre, she said: “Glycerin may accomplish more complex mechanism beyond water absorption. It may interact with the skin lipid structure and alter their water-binding properties. This effect causes an expansion of skin cells on the outermost skin layer, and between those cells, leading to a visible full thickness of the skin layer. With an improvement of water-holding abilities, it results in more effective moisturization of the skin.”
Repeated applications of lotions with high glycerin content have been found to improve skin hydration.
Ingredient you want in your moisturizer: squalane
Found in certain fish oils such as shark liver oil, squalene is a polyunsaturated hydrocarbon. As squalene is unstable and oxidizes easily, squalane has gained more attraction in the area of cosmetics. As a saturated derivative of squalene, squalane’s inert properties and low toxicity have paved its way into the cosmeceutical industry, favoured over its unsaturated analog, squalene. Although squalane is produced naturally by the body, we experience a slower production of this hydrocarbon when we hit thirty.
Squalane has high emollient properties, being absorbed easily by the skin without leaving an oily residue. An emollient helps keep our skin hydrated and supple by reducing water loss from the epidermis. Squalane increases skin hydration due to skin surface occlusions. Occlusives provide a layer of oil on the skin surface to reduce water loss from the stratum corneum.
These properties accentuate the moisturizing effect of squalane and coupled also with its stable nature, have contributed to a continual rise in demand for squalane in cosmeceutical approaches.
To round things up, make a mental note to check the ingredient list before you purchase your moisturiser. A good moisturiser would contain at least one of these ingredients: squalane, glycerin or ceramides. Even better, the Multi-CERAM moisturizer contains all 3 ingredients and more. This makes the Multi-CERAM a popular choice with our dry skin and eczema patients. With these points in mind, a good moisturiser can be easily differentiated from the plethora of options out there.